Scaffold For Spring Ligament Repair

ABSTRACT

A construct is disclosed that may be used to repair or replace a natural ligament. The construct may be formed of materials for biocompatibility and/or resorbtion. The construct may be provided or connected to a soft anchor for connection to a bone portion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No. 61/783,976, filed on Mar. 14, 2013. The entire disclosure of the above application is incorporated herein by reference.

FIELD

The subject disclosure is generally directed towards ligament repair and/or augmentation, and particularly to an augment construct that is configured to replace or augment a spring ligament in a foot.

BACKGROUND

This section provides background information related to the present disclosure which is not necessarily prior art.

A spring ligament is an anatomical ligament that interconnects various portions of a foot. Generally, the spring ligament may interconnect at least a navicular and a calcaneus. Various branches of the spring ligament, however, may also extend to connect or interconnect the calcaneus with the first cuneiform.

Injury to the spring ligament may lead to various issues, such as flat-foot deformities. Injuries to the spring ligament may not generally be diagnosed or repaired until various auxiliary issues present themselves, such as flat-foot deformities. Repairing a defect in the spring ligament, therefore, may lead to prevention of various afflictions.

SUMMARY

This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

A ligament construct may be manufactured to repair or replace a selected ligament. For example, a spring ligament replacement or augment may include a synthetic scaffold that may be formed or manufactured to generally replace the spring ligament. The synthetic scaffold may be formed of polyester, polyethylene, resorbable materials, or combinations thereof. The synthetic scaffold may be formed of a woven or braided polyester or polyethylene material that is formed into selected configuration or shape to replace the spring ligament.

Selected suture anchoring systems and tensioning systems may be used to fixedly connect the ligament augment to the anatomy. For example, a Juggerknot™ soft anchor or suture anchor may be used to provide an anchor adjacent to or inside of a bone member. Alternatively, a ToggleLoc™ hard suture anchor may be used. A suture tensioning system, such as the Ziploop™ suture tensioning system may be used to draw the scaffold into the bone, and tension the augment relative to the bone while the Juggerknot™ anchor system is used to anchor the construct. It is understood, however, that the tensioning system may be used in combination with any appropriate anchor, such as an interference screw or other bone anchor system.

The scaffold may be used to replace the spring ligament. For example, a user may identify a spring ligament tear or removal from a bone portion and identify a need for an augment or ligament replacement. The spring ligament construct may then be fixed relative to the bone, such as with an appropriate anchor and tensioning system. The anchors may include the Juggerknot™ soft anchor system. The construct may then be maintained relative to the bone for a procedure and/or fixed to the remaining portion of the spring ligament to assist in augmenting the remaining spring ligament portions.

Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.

FIG. 1A is a top plan view of a ligament construct connected to suture, according to various embodiments;

FIG. 1B is a side plan view of the ligament construct of FIG. 1A connected to suture;

FIG. 2A is a top plan view of a ligament construct according to various embodiments;

FIG. 2B is a side plan view of the ligament construct of FIG. 2A connected to suture;

FIG. 3 is a top plan view of a ligament construct according to various embodiments;

FIG. 4 is a detail view of a portion of a ligament construct connected to a suture and an anchor, according to various embodiments;

FIG. 5 is a side plan view of bones of a human foot illustrating a partial implantation of a ligament construct in a navicular bone;

FIG. 6 is a side plan view of bones of a human foot illustrating a partial implantation of a ligament construct in a navicular bone and calcaneus bone;

FIG. 7A is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone and calcaneus bone;

FIG. 7B is a bottom plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone and calcaneus bone;

FIG. 8 is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a cuneiform, a navicular bone, and a calcaneus bone, according to various embodiments;

FIG. 9 is a top plan view of a ligament construct connected to a suture, according to various embodiments;

FIG. 10 is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone, talus bone, and calcaneus bone, according to various embodiments;

FIG. 11 is a side plan view of the ligament construct of FIG. 1A connected to suture;

FIG. 12 is a top plan view of a ligament construct connected to suture, according to various embodiments;

FIG. 13 is a top plan view of a ligament construct connected to suture, according to various embodiments; and

FIG. 14 is a side plan view of the ligament construct of FIG. 1A connected to suture.

Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference to the accompanying drawings.

With reference to FIGS. 1A and 1B, a ligament augment or replacement construct 20 is illustrated. The ligament construct 20 may be formed of selected materials, such as a woven or braided polyester or polyethylene material. Additionally, various absorbable materials may be included or used to form the construct 20, such as polylactic acid or other selected materials. The construct 20 may be formed of a woven material and/or formed of a solid material of a selected type. The construct 20, according to various embodiments, may be resilient with little to no elasticity. Thus, the length of the construct 20 may be selected and maintained during implantation. Also, the construct 20, therefore, may be tensioned and maintain a tension after implantation.

The construct 20 may include a selected length 22 that extends between a first end 24 and a second end 26. The two ends 24, 26 may be formed by folding terminal end regions 28 and 30 over and towards a center of the construct 20. The terminal ends 28, 30 may be folded onto a body portion 36 of the construct 20. The terminal ends 28, 30 may be stitched, sonically welded, or otherwise fixed with a mechanism 32, 34 to the main body portion 36 of the construct. The folding over of the terminal ends 28, 30 may form passages, also referred to as eyelets, a loop, or open regions 40 and 42 near the ends 24, 26 of the construct 20. The passages, as discussed herein, may be engaged or coupled to sutures and/or anchor members.

The main body portion, or selected portions of the construct 20, may have a thickness 44 based upon various characteristics of the construct 20, such as strength, rigidity, elasticity, and the like. Moreover, it is understood that if the construct 20 is formed of a braided, woven, or other selected material material that the thickness 44 may decrease under a load between the two eyelet portions 40, 42. The thickness 44, however, may be defined by one or more strands of a woven material

According to various embodiments, the eyelets 40, 42 may be formed around suture and one or more suture constructs including a first suture construct 50 and a second suture construct 52; and/or the suture constructs 50, 52 may be formed within the eyelets 40, 42 and around the construct 20. The suture constructs 50 and 52 may be separate, but substantially identical and interconnected with the separate eyelets 40, 42 for fixation of the construct 20 relative to a selected anatomy, as discussed further herein. The suture constructs 50, 52 may be similar to the suture constructs disclosed in U.S. Pat. No. 8,118,836, issued Feb. 21, 2012; U.S. Pat. App. Pub. No. 2011/0098727, published on Apr. 28, 2011; or U.S. Pat. App. Pub. No. 2012/0095470, published on Apr. 19, 2012; all incorporated herein by reference.

Generally, the suture constructs may include respective anchors that may be formed as tubes 54, 56 through which a suture or selected filament 58, 60 passes. The suture 58, 60, when acted upon by a user, may cause the tubes 54, 56 to form an anchoring mass as knots or soft anchors to hold the construct 20 in a selected position. The anchoring mass can be formed on an exterior surface of a bone or formed within a bone surface, as discussed further herein. The suture anchors may include the Ziploop™ constructs to allow for slip tensioning of a portion positioned relative to the Ziploop suture construct and a Juggerknot™ anchor portion that may be formed by the respective tubes 54, 56. Each of the Ziploop™ suture construct and the Juggerknot™ soft anchor portion are sold by Biomet, Inc.

The sutures 58, 60 may further pass through a body or passage portion 70, 72 where two suture ends of each suture construct 50, 52 extend from the respective passage portions 70, 72. Each of the sutures 50, 52 has the respective passage portion 70, 72 and each defines a respective through-passage through the passage portions 70, 72. Each suture construct 50, 52 further has two ends 76, 78 and 80, 82. For each suture construct the first end 76, 80 is passed into the through-passage through a first aperture to form a first loop and exits the through-passage through a second aperture and the second end 78, 82 is passed into the through-passage through a third aperture to form a second loop and exits the through-passage through a fourth aperture. It is understood, according to various embodiments, the first and third aperture may be the same aperture as may the second and fourth aperture. Thus, each passage portion may include 2, 3, or 4, or a selected number of apertures into the through-passage of the passage portion. Each of the two suture ends 76, 78 and 80, 82 may be acted upon by a user to collapse the respective anchors 50, 56 to form the soft anchoring masses and tension the construct 20 between two points of the anchors 54 and 56, as discussed further herein.

The anchor assemblies 50, 52 including the anchors 54, 56, also referred to as tubes, which may generally include a collapsible tube that is a closed loop of suture material that is formed into the tube shape. According to various embodiments, the tube assembly 54, 56 may be slideable relative to the suture loops or filaments 58, 60. Briefly, although disclosed in the U.S. Pat. No. 8,118,836, incorporated herein by reference, the suture assemblies 50, 52 may include the suture portions 58, 60 that pass through openings 55, 57 of the respective tubes 54, 56. Alternatively, the suture portions may pass out an aperture that is not at the openings 55, 57 such that one or both ends of the tubes 54, 56 form flaccid or unbound ends.

Generally, the suture portions 58, 60 may be single or continuous suture filaments that extend through the respective tubes, 50, 56 in the respective braided bodies 70, 72 of the suture assemblies 50, 52. The suture assemblies 50, 52, therefore, may be manipulated by a user to generate a soft anchor, as discussed herein, by collapsing the respective tubes 50, 56, and tensioning the construct 20 relative to selected areas of a subject by moving the ends 76-82 to tension the construct 20 relative to the respective anchors formed by the tubes 54, 56. The anchors 54, 56 collapse under a force, such as a tensile force, provided by or through the respective suture portions 58, 60 to form soft or anchor masses in respective areas, as discussed further herein. The tubes 54, 56 may form the anchors by collapsing the tubes 54, 56 relative to a positive or adjacent surface of the tube 54, 56.

With reference to FIGS. 2A and 2B, a construct 100 is illustrated. The construct 100 may be similar to the construct 20 in general construction. For example, the construct 100 may be formed of a woven selected material, such as polyester or polyethylene. Additionally, the construct 100 may be formed from a selected material including bio-absorbable materials that may be absorbed into a selected anatomy over time and allow for ingrowth of various tissues to replace portions of the construct 100.

The construct 100, however, may also be formed in a substantially elongated and rectangular construct including a length 102 from a first end 100 a to a second end 100 b of about 4 centimeters (cm) to about 10 cm, and further including 4 cm to about 8 cm. Additionally, the construct 100 may include a width 104 that is about 0.5 cm to about 4 cm, including about 1-3 cm, and further including about 1 cm to about 2 cm. The construct 100, as illustrated in FIG. 2B, may further include a thickness 106 that is about 0.5 millimeters (mm) to about 4 mm, and further including about 1 mm to about 3 mm.

The construct 100 may include one or more bores 110 formed from a first side to a second side through the thickness 106 of the construct 100. The bores 110 may be formed in a selected configuration, such as near a perimeter of the construct 100. The bores 110 are generally formed at or near both of the ends 100 a, 100 b of the construct 100. Thus, the ends 100 a, 100 b of the construct 100 can be engaged and tensioned relative to selected anchoring regions, as discussed herein. The bores 110 may allow for passage of selected anchor assemblies, such as an anchor assembly 120, as discussed further herein. Any appropriate anchoring assembly, such as the construct 50, however, may also be used.

The anchor assembly 120 may pass through one or more of the throughbores 110 to allow for fixation of the construct 100 relative to a selected subject. The bores 110 may be throughbores formed through the construct 100 through various techniques such as puncturing, drilling, ultrasonic welding or puncturing, or other appropriate mechanisms. Also, the through bores 110 may be formed between braided or woven fibers of the construct 100. Regardless, the bores 110 may be throughbores formed through the entire thickness 106 of a construct 100 to allow for passage of anchor assemblies 120.

The anchor assembly 120 may be an anchor assembly including an anchor assembly as disclosed in U.S. Pat. No. 8,118,836, incorporated herein by reference. The anchor assembly 120 may include various portions similar to the anchor assemblies 50, 52 described above. Generally, the anchor assembly 120 may include a first collapsible anchor 122 (also referred to as a tube) and a second collapsible anchor 124 (also referred to as a tube) which are disposed about or around respective suture loops 126 and 128 that are a part of a single elongated suture of the anchor assembly 120. As tension is applied on the respective suture loops 126, 128, the anchors 122, 124 collapse and may form anchoring masses relative to selected portions of a subject, similar to the anchors 54, 56 discussed above. It is understood that the respective suture anchors 122, 124 may be collapsed simultaneously and/or at staggered times, as selected and/or desired by a user.

The suture loops 126, 128 are portions of a suture 130 that further include suture ends 132 and 134. The suture ends may be gasped or manipulated by a user to collapse the tubes 122, 124 to form the soft anchors. Additionally, the suture 130 may be passed through a passage portion 140 having a through-passage as discussed above and as disclosed in U.S. Pat. No. 8,118,836, incorporated herein by reference. The suture ends 132, 134 may be manipulated to move the passage portion 140 relative to the tubes 122, 124. As discussed above, the movement of the passage portion 140 relative to the tubes 122, 124 may tension the construct 100 relative to the tubes 122, 124 when the tubes are collapsed against a respective positive surface, such as a bone surface. Accordingly, the construct 100 may be tensioned relative to a bone surface as discussed further herein by pulling on the ends 132, 134 of the suture loop 130.

With reference to FIG. 3, a construct 170, according to various embodiments, is illustrated. The construct 170 may include various dimensions, such as a length 172 that may be about 3 cm to about 10 cm, including about 4 cm to about 8 cm. The construct 170 may further include a height 174 that includes a selected height of about 1 cm to about 4 cm, including about 2-3 cm. The height 174 may include a height or a length of arm portions 176 and 178 that extend from a main body portion 180 of the construct 170. The main body portion 180, however, may include an end 182 that may include a height 184 having a dimension of about 0.5 cm to about 2 cm, and further including a height of about 1 cm.

The construct 170 may be similar in construction to the constructs 20 and 100, as discussed above. Accordingly, the construct 170 can include any selected portion to interconnect with a suture and/or anchor assembly. For example, an eyelet can be formed near the terminal ends of the construct and/or throughbores may be formed through the construct 170. For example, a suture construct 52 a that includes an anchor 56 a can be coupled to an eyelet formed by folding over a terminal end and fixing it with a fixing structure 183 near the first end 182. The suture construct can be similar or identical to the suture construct 521. It is understood that each arm 176, 178 can include a fold formed eyelet and one or more throughbores and individual coupled suture constructs, according to various embodiments.

The construct 170, however, may include the single end 182 and the two arms 176 and 178 extending from an area at the second end of the construct 170. As discussed herein, the first end 182 may engage a first bone member or portion while the two arms 176 and 178 may engage separate bone members or constructs as discussed herein. Thus, at each arm 176, 178 and the first end 182 a suture construct including an anchor portion can be connected. Fixation of the construct 172 to selected bone portions may include various suture anchors and assemblies 50, 52 and 120 as discussed above. Accordingly, the construct 170 may be fixed relative to a selected portion of a subject similar to the fixation or anchoring mechanisms as discussed above.

With reference to FIGS. 1A-1B, discussed above, and additional reference to FIG. 4, the construct 20, or construct according to various embodiments as discussed above, may be engaged or associated with an anchor assembly 190. The anchor assembly 190 may include a fixation member 192, such as a Toggleloc™ anchor, sold by Biomet, Inc., that is rigid. The rigid fixation member 192 may include that illustrated and disclosed in U.S. Patent Application Publication No. 2012/0116452 and U.S. Pat. No. 7,695,503, both incorporated herein by reference. In addition, the anchor 192 may be interconnected or associated with a suture assembly 202, similar to the suture assemblies 50, 52 discussed above. The suture assembly 202 may include a passage portion 204 to which a continuous suture 206 is passed. The continuous suture 206 may include a continuous loop of suture that passes through the passage portion 204. The passage portion 204 may be formed through the anchor 192, as illustrated in FIG. 4.

The construct 20 may also be formed around the filament or loop portions of the suture portion 208 to engage the construct 20 relative to the anchor 192. The construct 20 may have the eyelet 42 formed by suturing or interconnecting an end 30 of the construct 20 with a suture portion 34. The construct 20, therefore, may be held relative to the anchor 192 with the suture assembly 202. Generally, the anchor 192 may include an elongated arm portion 220 and an eyelet or interconnection portion 222 to engage the suture assembly 202.

Accordingly, it is understood that the construct, according to various embodiments including the construct 20, the construct 100, and the construct 170, may be interconnected with a selected anchor or connecting portion. The connecting portion may include soft anchors, such as those illustrated with the suture assembly 50 or the suture anchor assembly 120. Additionally, a hard or rigid fixation member may include the fixation member 192 illustrated in FIG. 4.

The ligament construct, according to various embodiments as discussed above, may be provided relative to a selected portion of a subject, such as a foot 300 of a subject, illustrated in FIG. 5. The foot 300 of the subject may include various anatomical bone portions, such as those generally known in the art. For example, the foot 300 may include phalange members 302, metatarsal members 304, a medial (first tarsal) cuneiform 306, a navicular 308, a talus 310, and a calcaneus 312. The foot 300 may be connected or articulated with other boney portions, such as a tibia and a fibula, as is generally understood in the art.

With additional reference to FIG. 5, the various boney portions of the foot 300 may be interconnected with a construct, including the various embodiments of a construct as discussed above. For exemplary purposes, the construct 20 is illustrated and discussed. It is understood, however, that the construct 100 may be used relative to the foot 300 including the suture assembly 50, 52 and/or the anchor suture assembly 120, as discussed above. Nevertheless, for illustration of a selected procedure to replace a spring ligament or augment a spring ligament in a foot 300, the construct 20 is discussed further herein.

As illustrated in FIG. 5, the navicular 308 may be configured to include a throughbore 320 through which the anchor 54 may be passed and collapsed upon an exterior bone surface of the navicular 308 to form the anchoring mass or portion 54′, such as a soft anchor, relative to the navicular bone 308. The anchor portion 54′ may be defined as a large or anchoring mass formed near the bone surface. A locking profile of the tube 54 may allow the anchoring mass to be formed by the application of a tensile force with the suture 58. The bore 320 may be formed to allow for passage and receipt of at least a portion of the construct 20 into a portion of the bore 320. The drawing or tensioning of the construct 20 into the bore 320 may be performed with the suture assembly 52 by drawing or tensioning the suture ends 76, 78 and drawing the construct 20 into the bore 320. The formation of the bore 320 and tensioning of the construct 20 into the bore 320 will be discussed further in relation to the calcaneus 312 in a bore 340 formed therein, discussed further herein.

With a continuing reference to FIG. 5, the calcaneus 312 may have a bore 340 formed therein including a plurality of diameters. For example, a first or small drill/pin 342 may be passed through or drilled through the calcaneus 312 to form a small bore or first bore passage 344. A second or larger drill bit 349 (the larger drill bit 349 may be cannulated) may be passed over the small bit 342 to form a second or larger bore 352. Accordingly, the bore 340 formed through the calcaneus 312 may include a first diameter bore 344 and a second diameter bore 352. The bore 320 formed in the navicular 308 may include a similar large diameter bore portion and a small diameter bore portion. The large diameter bore portion may receive a portion of the construct 20 while the small diameter bore portion may allow for passage of the suture construct 50, 52 to allow for movement of the respective tubes 54, 56 to a second portion of the respective bone to form the soft anchor relative thereto. Moreover, a shoulder or ledge 320 a, 340 a is formed within the respective bores 320, 340 due to the different diameters.

With reference to FIG. 6, the anchor assembly, including the suture anchor assembly 52 that is connected to an end of the construct 20, may be passed through the bore 340 formed to the calcaneus 312, or selected bone portion. The suture assembly 52 and/or only the anchor 56 alone may be passed through the bore 340. An appropriate passing member may interconnect with the anchor 56 and/or the suture ends 80, 82 to push or pull the suture assembly through the bore 340 formed to the calcaneus 312. The construct 20 interconnected with the suture anchor assembly 52, however, may be moved relative to the calcaneus 312 to allow for passage of the suture anchor assembly 52 through the bore 340 formed through the calcaneus 312.

As illustrated in FIG. 6, the construct 20 may be pulled into the bore 320 formed in the navicular 308 and the anchoring portion 54′ may be formed relative to the navicular 308 by tensioning the anchor 54 relative to the navicular 308, as is generally understood in the art. The suture assembly 52 may then be moved through the bore 340 formed through the calcaneus 312, as illustrated in FIG. 6. It is understood, however, that the suture assembly 52 may be first passed through the calcaneus 312 prior to passage of the suture assembly 50 through the navicular 308. The order of placing the anchors relative to individual bone portions is exemplary, and not intended to be limiting. Aafter forming the bore 340 through the calcaneus 312, the suture assembly 52 may be passed through the calcaneus 312. According to various embodiments, the anchors, including the soft anchors, can be formed on the surface of the bone portions at all selected anchoring points. Then each end of the construct can be alternatingly tightened to substantially ensure uniform tensioning of the construct 20.

The passage of the suture assembly 52 through the calcaneus 312 may generally be in the direction of arrow 313. The passage of the suture assembly 52 may be according to appropriate mechanisms, such as pulling the suture assembly 52 through the bore 340 or pushing the suture assembly 52 through the bore 340. Generally, however, the anchor 56 may be passed through a distal cortical bone portion 391 a, as illustrated in FIG. 7A, and a second cortical bone portion 391 b, is also illustrated in FIG. 7A. The bore 340 may further be formed through both of the cortical bone portions 391 a and 391 b and further through the cancellous bone portion 389, therebetween.

Accordingly, a soft anchor may be formed by the anchor 56 on an exterior distal surface of the cortical bone portion of the calcaneus 312. The anchor 56 may be formed by drawing the construct 20 into the large bore portion 352, by manipulating the ends of the suture filaments 80, 82, to form the soft anchor 56′. The construct 20 may then be tensioned and drawn into the bore 340.

With continuing reference FIGS. 5 and 6, and additional reference to FIGS. 7A and 7B, the construct 20 may be tensioned into the bore 320 formed within the navicular 308 and the bore 340 formed in the calcaneus 312. The bore 320 in the navicular 308 may include a large bore portion 320 a and a small bore portion 320 b similar to the large bore 352 and the small bore portion 344 formed through the calcaneus 312. The large bore portion, of both the navicular 308 and the calcaneus 312, may include a diameter 352 a such as about 4 mm to about 6 mm. The small bore portion of both the calcaneus 312 and the navicular 308 may include a diameter 344 a of about 2 mm to about 4 mm. It is understood, however, that the bore formed through the respective bone portions may be any appropriate diameter to receive the constructs positioned within the respective bore portions and interact with the anchor members positioned relative to the bone portions.

The anchor portion 54′ formed by the tube 54 and anchor portion 56′ formed by the tube 56 may be formed on an exterior surface of the bone portions 308, 312 such as on an exterior surface of the cortical bone thereof. The anchor portions 54′, 56′ can fix or anchor the construct 20 relative to the bone portions. The anchor portions 54′, 56′ may be defined as a large or anchoring mass formed near the bone surface. A locking profile of the tubes 54, 56 may allow the anchoring mass to be formed by the application of a tensile force with the suture 58, 60. The construct 20 may then be tensioned relative to the anchor portions 54′, 56′ to form a selectively tensioned construct 20 relative to the two bones of the navicular 308 and the calcaneus 312 to augment or replace the spring ligament.

The soft anchors 54′, 56′ however, may be formed within the respective bone portions 308 and 312 relative to a cancellous bone portions 389 and 367 to engage the proximal cortical bone portions 391 b and 369 of the respective bone members 308 and 312. Accordingly, the soft anchor portions 54′, 56′ need not be formed on the exterior surface of the respective bone member 308 and 312 to anchor the construct 20 relative to the respective bone portions 308 and 312. Rather, the bone anchors or construct anchors may be formed within the bone surfaces to provide for fixation of the construct 20 relative to the respective bone members 308 and 312. Formation of an anchor assembly within the bone member may be formed as discussed above and with an anchor assembly as disclosed in U.S. Patent Application 2011/0098727, published Apr. 28, 2011, incorporated herein by reference. The formation of the soft anchor 54′, 56′ may be substantially similar, save that the soft anchor is formed within the tunnel 340 and 320 of the respective bone members.

The construct 20 may be positioned relative to respective bone portions, such as the calcaneus 312 and navicular 308, as discussed above and illustrated in various figures, including FIGS. 6-7B. The construct 100 may be similarly positioned between two selected bone portions, such as the calcaneus 312 and navicular 308. According to various embodiments, the construct 170 may be interconnected with two or more bones portions of the foot 300, as illustrated in FIG. 8. The construct 170, including the main body portion 180, the arm member 178, and the arm member 176 may be connected or positioned relative to the navicular 308 and the first cuneiform 306. Additionally, the end of 182 of the main body 180 may be positioned relative to the calcaneus 312 of the foot 300.

The fixation of the construct 170 relative to the respective bone portions may be with the suture anchor construct, such as the suture anchor construct 52. Accordingly, each of the ends of the construct 170 may be coupled to bone portions with a suture anchor such as the suture anchor at 56 a relative to the first cuneiform, a suture anchor 56 b relative to the navicular 308, and a suture anchor 56 c relative to the calcaneus 312. It is understood, however, that the various anchor of fixation members may be positioned relative to the respective boney members, including the first cuneiform 306, navicular 308, and the calcaneus 312, to fix the construct 170 relative thereto. For example, the suture anchor assembly 120 may be interconnected with the construct 170 to anchor relative to the selected bone portions in addition to the anchor fixation member 190, as illustrated in FIG. 4.

Accordingly, a ligament construct may be provided to augment and/or replace the spring ligament. The ligament construct, therefore, can interconnect various portions of the foot 300, including the calcaneus 312 and the navicular 308. In various embodiments, the first cuneiform 306 may also be interconnected relative to the navicular 308 and the calcaneus 312. The interconnection of the respective boney portions of the foot 300 may be provided to augment or replace the spring ligament of the foot 300. The spring ligament to the foot 300 may be further augmented by interconnecting the respective construct, such as the construct 20 or the construct 170, with the spring ligament. The interconnection of the construct relative to the spring ligament may be provided by further suturing the construct to the spring ligament. For example, the construct may be sutured directly to the spring ligament by generally known suture techniques such as threading or knotting the appropriate construct to a portion of the spring ligament that is remaining in the foot 300. For example, the spring ligament may be interconnected by the navicular bone 308 portion and the augment may be sutured to the spring ligament that remains connected at the bone portion. Accordingly, it is understood that the construct, as discussed above, may be provided to replace or augment the spring ligament in the foot 300. Moreover, the construct may be interconnected with a respective bone portion of the foot 300, according to various embodiments, including those discussed above. The construct, such as the construct 20, the construct 100, or the construct 170 may be formed through various weaving and molding techniques to provide an appropriate construct to replace or augment the spring ligament in the foot 300.

With reference to FIGS. 9 and 10, a deltoid ligament in the foot 300 can interconnect a tibia 321 relative to the foot 300. The deltoid ligament can interconnect the tibia 321 relative to the calcaneus 312, the navicular 308, and a talus 322. The tibia 321, the talus 322, the navicular 308 and the calcaneus 312 can be interconnected with a construct 350, as illustrated in FIG. 9. The ligament construct 350 can include construct bodies 350 a and 350 b that are formed similar to the ligament construct 20, as discussed above. Accordingly, the construct bodies 350 a and 350 b can be formed as substantially elongated members extending between first and second respective ends and can be formed of a woven polymer material and/or a solid material.

According to various embodiments, the first construct body 350 a can extend from a first end 360 that has a first eyelet formed by folding over and fixing (e.g. via suturing or sonically welding) with a fixing member or system 362 a terminal end of the main body to an internal position of the body 350 a. Positioned through the eyelet at the first end 360 can be a first suture construct 364. The first suture construct 364 can be similar to the suture construct 50 discussed above, and will not be described here in detail. Nevertheless, the suture construct 364 can include a collapsible tube 366 that is formed around a suture 368 that passes through a passage portion 370 with first and second suture ends 372 and 374 extending therefrom. As discussed above, the suture construct 364 can be positioned relative to a bone portion, as discussed further herein, to allow the collapsible tube 366 to form an anchoring mass by drawing or pulling on the suture end 372 and 374.

The first construct body 350 a may extend from the first end 360 to a second end 380 that also has an eyelet that may be formed by fixing a terminal end at the second end 380 with a fixation portion 382. A second suture construct 390 can also be passed through the eyelet that includes a collapsible tube 394 formed around a suture 396. The suture 396 can have a passage portion 398 through which the suture passes and a first end 400 and a second end 402 extends therefrom. Again, the suture construct 390 can be used to tension and anchor the first body 350 a relative to selected boney portions, as discussed further herein.

Additionally, passed or formed through the eyelet at the second end 380 can be the second construct body 350 b. The second construct body 350 b can extend from a first end 420 that forms an eyelet by having a terminal end portion fixed a distance from the terminal end with a fixation mechanism 422. Passed through the eyelet formed at the first end 420 can be a third suture construct 430, similar to the suture constructs 364 and 390. Accordingly, the suture construct 430 can include a collapsible tube 432 that is formed around a suture 434 that passes through a passage body or portion 436 with a first terminal end 438 and a second terminal end 440 extending therefrom. Again, the suture construct 430 can be used to fix or anchor the second body portion 350 b by forming the collapsible tube 432 into an anchor mass by pulling on the terminal suture ends 438 and 440.

The second construct body 350 b may extend from the first end 420 to a second end 450 that may also include a second eyelet formed by fixing a terminal end a distance from the terminal end with a fixation portion 452. A fourth suture construct 460 can also be passed through the eyelet formed at the second end 450. The fourth suture construct 460 can include a collapsible tube 462 that is formed over a suture 464. The suture 464 can include a passage portion 466 from which extends a first terminal suture end 468 and a second terminal suture end 470. Therefore, the fourth suture construct 460 can also be used to form an anchoring mass by drawing the terminal suture ends 468 and 470 as discussed above.

The augment or replacement construct 350 can be used to interconnect at least a tibia 321, talus 322, navicular 308, and calcaneus 312 by positioning the respective suture constructs, 390, 430, 460, and 364 in bone tunnels formed in the respective bone portions. Without repeating the procedure discussed above for forming the bone tunnels, bone tunnels can be formed in and/or through each of the bone portions similar to a manner as discussed above. Accordingly, a first tunnel 500 can be formed in the tibia 321 and the collapsible tube 394 can be formed into the anchoring mass 394′ on an exterior surface of the tibia 321. A portion of the construct 350 can then be tensioned or drawn into the tunnel 500, as discussed above. A second tunnel 520 can be formed through the talus 322 and the collapsible tube 432 can be formed into the anchoring mass 432′ on an exterior surface of the talus 322. A portion of the construct 350 can be tensioned into the tunnel 520, as discussed above. A third tunnel 530 can be formed in the calcaneus 312 and an anchor mass 366′ can be formed from the collapsible tube 366 and the construct can be tensioned into or onto the calcaneus 312, as discussed above.

A fourth tunnel 540 can be formed into the interior talus or, alternatively, into the navicular 308 (shown in phantom at 540′). It is understood, however, that if the alternative tunnel 540′ is formed in the navicular 308 the tunnel 540 may also be formed in an anterior portion of the talus 322 to allow connection of the navicular 308 and the talus 322. The suture construct can be similar to the anchor 120, illustrated in FIG. 2B, to allow for interconnection with a tunnel formed in the anterior portion of the talus 322. Accordingly, it is understood that the construct 350 can be provided to interconnect a plurality of bone portions of the foot 300 including interconnection with a leg bone portion, such as the tibia 321. Moreover, it is understood that the suture constructs can be provided in various configurations to allow for fixing of the ligament or tendon construct 350 to the respective bone portions.

With reference to FIGS. 11 and 12, a ligament augment or replacement construct 600 is illustrated. The ligament construct 600 can be substantially similar to those discussed above, such as the construct 20 illustrated in FIGS. 1A and 1B. For example, the ligament construct 600 can be formed of various materials, such as polylactic acid and/or other absorbable materials. The construct 600 can be formed as a woven, braided, or a solid material. Moreover, one or more of a terminal end 602 of the ligament construct 600 can be folded inward or inboard toward a center of the ligament construct 600. Thus, the terminal end 602 is folded upon the construct 600 to form one or more folded portions or regions 603. The construct 600, therefore, can have a portion that is folded upon itself, as in the folded region 603. The folded region 603 can include a first loop region or eyelet 610 and an overlap region 612.

The folded portion, or at least a portion thereof, can be adhered in place with welding points 604 and 606 and/or stitching or suturing. The folding over of the terminal end 602 onto the body of the ligament construct 600 can form the first loop region or eyelet 610. Formed in the overlap region 612 of the terminal end 602 onto the ligament construct 600 can be a bore eyelet 614. The bore eyelet 614 can be formed through both a main portion 618 of the ligament construct and the overlap portion 620 that extends from the terminal end 602. Accordingly, the bore eyelet 614 can be formed through two layers of the ligament construct 600.

As illustrated in FIG. 12, a second terminal end 630 can also be folded over on the ligament construct to form a second overlap region 632 similar to the first overlap regions 612. A second throughbore eyelet 634 can also be formed through the overlap region 632, such as with sonic welding or boring. Thus, both ends of the construct 600 may have bores formed therethrough.

A suture construct or at least a portion thereof, such as the suture construct 50, may be passed through or formed through the first bore 614. The second suture construct 52 can be passed through the second bore 634. Accordingly, the ligament construct 600 can be provided for use in a procedure similar to the construct 20, discussed above. The suture constructs 50 and 52, however, can pass through bores 614 and 634 formed through overlap regions 612 and 632 rather than through the eyelet 600 formed through the construct ends 602, 630 or by the overlap of the suture ligament construct 600.

By providing the bores 614 and 634 through an overlap region, the withdrawal or pull-out strength may be increased by providing a greater mass and width of the ligament construct 600 to be pulled through. The eyelets 614 and 634 may be formed at any appropriate selected location relative to the ligament construct 600 and the fold-over eyelet 610 and need not be formed at a terminal end of the overlapped ligament construct 600.

With reference to FIGS. 13 and 14, a ligament construct 650 is illustrated. The ligament construct 650 can extend from a first end to a second end, similar to the ligament constructs discussed above, including those illustrated in FIGS. 1A and 1B. Each end of the ligament construct can include at least one eyelet 652 similar to the eyelets 40 and 42 of the ligament construct 20. The eyelet 652 can be formed similar to the eyelet as discussed above, such as overlapping or folding over a terminal end 654 of the suture construct 650 and fixing it with a weld or suture element 656. The eyelet 652 of the ligament construct 650 can be rounded or curved relative to a width 650 w of the ligament construct 650.

A first edge 660 can be folded or rolled towards an axial center line or longitudinal axis 662 of the ligament construct 650. A second edge 664 can also be folded or rolled towards the central axis 662. The first edge 660 and the second edge 664 can be exterior lateral or longitudinal edges. Each of the edges 660, 664 can be folded towards a central longitudinal axis 662 of the construct 650, as discussed further herein. Accordingly, the folded or rolled dimension relative to the fold width 650 w at the rolled region can be less than the width 650 w and can include a width 670. The width 670 can be less than the fold width 650 w as defined in phantom 672 in FIG. 13.

The suture construct 50 can be passed or formed through the eyelet 652 similar to the suture construct 50, 52 discussed regarding FIG. 1A. It is further understood that the ligament construct 650 can include a second end and may have a similar eyelet 652 or an eyelet similar to those discussed above. A second suture construct can be passed through the second eyelet of the ligament construct 650 in a manner similar to that described for the construct 350.

The end of the ligament construct 650 including the eyelet 652 can be passed through a bore, such as a bore in a bone, as illustrated above in FIG. 6. The eyelet 652 formed by folding the edges 660 and 664 can reduce a width of the eyelet region 652 to be less than a width 650 w of the ligament construct 650. Accordingly, the eyelet portion 652 can be efficiently inserted into a bore formed in a bone. Additionally, rolling or folding the edges over can provide a smoother and/or contoured edge to minimize contact with a bore and ease passage through a bore. The rolled and folded edges can be maintained in their rolled and folded configuration by a fixation member, such as a suture 680 or other appropriate adhesive. The eyelet 652 can therefore, be formed with the ligament construct 650 for positioning relative to and/or passing through bores formed in boney portions.

It is understood that the various embodiments of the construct including the eyelets discussed above can be formed in substantially similar manner and interchanged for various purposes. The construct can be used for various purposes, including ligament and/or tendon repair, augmentation, or replacement. Moreover, a selected eyelet can be formed in an appropriate manner for selected procedures, as is understood by one skilled in the art. Moreover, forming the eyelets in various manners can be used for productions, efficiencies and/or costs and specific procedures.

The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and may be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure. The terminology used herein is for the purpose of describing particular example embodiments only and is not intended to be limiting. As used herein, the singular forms “a,” “an,” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise. 

What is claimed is:
 1. A system for connection to a subject, comprising: an augment construct having a first terminal end, wherein the augment construct has a folded region where the first terminal end is folded to extend a length towards a center of the augment construct; a connection feature that connects a portion of the folded region such that the first terminal end is fixed inboard to the augment construct at a fixation location; and a first passage formed as a bore through the folded region; wherein the bore is formed through at least two layers of the augment construct material due to being formed through the folded terminal end portion and the inboard portion of the augment construct.
 2. The system of claim 1, further comprising: a second passage in the folded region defined between a first surface of the inbound portion of the augment construct and a second surface of the augment construct nearer the first terminal end and opposed to the first surface.
 3. The system of claim 1, wherein the connection feature includes at least a suture.
 4. The system of claim 1, wherein the connection feature includes at least an ultrasonic weld of the first terminal end at the fixation location.
 5. The system of claim 1, further comprising: a first suture construct coupled to the augment construct through the first passage; a first anchor coupled to the first suture construct.
 6. The system of claim 5, wherein the first anchor is a soft anchor coupled to the first suture construct; wherein the first suture construct has a passage portion that defines a through-passage, where a first end of the first suture construct is passed into the through-passage through a first aperture to form a first loop and exits the through-passage through a second aperture and a second end of the suture construct is passed into the through-passage through a third aperture to form a second loop and exits the through-passage through a fourth aperture.
 7. The system of claim 6, where the first soft anchor is a first collapsible tube configured to form a first anchoring mass coupled about the first suture construct.
 8. The system of claim 5, wherein the first anchor includes an elongated member with a connection region between the first anchor end and the second anchor end; wherein the elongated member is configured to engage a first surface and a second surface adjacent to a subject bore.
 9. An augmenting construct, comprising: a construct having a first end, wherein the construct has a folded region between a fold portion and an inward portion, where the first end is folded inwards towards a center of the construct to extend towards the inward portion of the construct; a fixation portion where the first end is fixed at the inward portion of the construct; a first passage formed as a bore through the folded region between the fold portion and the inward portion, wherein the bore is formed through at least two layers of a construct material of the construct in the folded region; a connection member connected to the construct at the first passage.
 10. The augmenting construct of claim 9, further comprising: an anchor connected to the connection portion, wherein the anchor is configured to anchor the construct to a subject.
 11. The augmenting construct of claim 10, wherein the anchor is a rigid anchor connected to the connection member.
 12. The augmenting construct of claim 10, wherein the anchor is a soft anchor coupled to the connection portion; wherein the connection portion has a passage portion that defines a through-passage, where a first end of the connection portion is passed into the through-passage through a first aperture to form a first loop and exits the through-passage through a second aperture and a second end of the connection portion is passed into the through-passage through a third aperture to form a second loop and exits the through-passage through a fourth aperture.
 13. The augmenting construct of claim 9, further comprising: a second passage defined by the construct formed as a second bore through the construct having at least one lateral side of the construct rolled towards a central longitudinal axis of the construct.
 14. The augmenting construct of claim 9, wherein the construct is formed of a bioabsorbable material.
 15. A method of forming an augmenting construct, comprising: folding a first end of a construct inwards towards a center of the construct to extend to an inward portion of the construct to form a folded region between a fold portion and the inward portion; fixing the first end at the inward portion of the construct; forming a first passage through the folded region between the fold portion and the inward portion, wherein the first passage is formed as a bore through at least two layers of a construct material of the construct in the folded region; connecting a connection member to the construct at the first passage; and providing an anchor with the connection member.
 16. The method of claim 15, further comprising: passing at least the folded region into a bore formed in a subject; and anchoring the construct relative to the subject by anchoring the provided anchor relative to the bore formed in the subject.
 17. The method of claim 16, further comprising: passing the provided anchor through the bore formed in the subject; positioning the anchor adjacent an exterior of the subject after passing the provided anchor through the bore; and tensioning the construct relative to the anchor positioned adjacent the exterior of the subject.
 18. The method of claim 17, wherein positioning the anchor adjacent the exterior of the subject includes positioning at least one arm extending from an anchor central region to contact the exterior and a central body region of the anchor extending towards a central axis of the bore.
 19. The method of claim 17, wherein positioning the anchor adjacent the exterior of the subject includes collapsing a collapsible tube into an anchoring mass on the exterior of the subject.
 20. The method of claim 16, further comprising: moving an exterior longitudinal edge of the construct towards a central axis of the construct; and holding the moved longitudinal edge near the central axis to form a decreased width region. 